Comprehensive Diabetes Foot Examination Form

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2. Current ulcer or history of a foot ulcer? Yes No 3. Is there pain in the calf muscles when walking that is relieved by rest? Yes No III. Foot Exam 1. Are the nails thick, too long, ingrown or infected with fungal disease? Yes No 2. Note foot deformities. Toe deformities Bunions Charcot foot Foot drop Prominent (C)metatarsal heads

  Ulcer, Foot, Foot ulcer, Foot foot